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WHO health briefing on Iraq

UN humanitarian briefing6 June 2003

The focus of work in the health sector in Iraq is on the programme to jump start the health system. This involves numerous elements, including training programmes, disease surveillance, medicine distribution, and finding solutions to security problems at hospitals, warehouses and other health facilities.

Communicable disease training and surveillance

WHO has for some weeks been reporting on outbreaks of cholera and leishmaniasis in southern Iraq. We have just completed an urgently needed training course in the city of Basra. The Workshop on Disease Surveillance and Health Information System focused on the details of gathering reliable information about infectious disease symptoms and outbreaks. This was a three-day workshop in the the Child and Maternal Hospital in Basra for directors of the health districts, as well as staff from the Centres for Disease Control in Basra and Baghdad. Further workshops will follow in order to evaluate the implementation of comprehensive disease surveillance. Last September, WHO trained Iraqi epidemiologists from different governorates for surveillance and control of communicable diseases in anticipation of the conflict. This workshop was a continuation and stepping up of this work. Its most important outcome is that all 82 health centers and 10 hospitals in Basra Governorate will report on a weekly basis on measles, whooping cough, typhoid, watery or bloody diarrhoea, cholera, leishmaniasis, injuries from mines and unexploded ordnance. More than 20 diseases are listed in a form WHO has developed and agreed by all partners to follow. Surveillance will also be expanded to the other three southern governorates (Missan, Thi Qar and Muthana). WHO will visit theses cities this week to assess the health situation and help the local authorities to resume their surveillance activities.

WHO has been working with officials and doctors in the health authority to revive the surveillance system in individual cities, governorates and ultimately across the country. Iraq had effective disease surveillance before the recent conflict, but the collapse of centralized authority meant that the system quickly fell into disuse. Initially, a number of sentinel sites were set up to gather and transmit information on patients being examined at individual hospitals and health centres. This has rapidly shown its importance in alerting the health authorities to localized outbreaks, including small outbreaks of measles, cholera cases in Basra and now one confirmed case of cholera in Baghdad. The sentinel sites are now being upgraded and routine surveillance information is again being collected from much of the country. Reports are now regularly coming in from all but two governorates. The information confirms that diarrhoeal disease, particularly among children, and upper respiratory tract infections, are the largest infectious disease problems in Iraq. It has also identified a possible case of malaria in Diyala governorate, north of Baghdad. A blood sample has been taken for further testing.

Medicine distribution

The state medicine supply and distribution company, Kimadia, was badly damaged by looting following the end of the recent conflict. Warehouses, offices, computers, doors and windows as well as medicines were either stolen or broken. The system is rapidly coming back to life. WHO has helped to provide computers, as well as money to rebuild the infrastructure. Medicines are now being distributed with increasing regularity. Nine major convoys have left Baghdad for the governorates and the system of communicating and coordinating needs for medicines and other supplies is being put back in place. Each convoy is accompanied by vehicles and forces from the Authority, which provide much-needed security to the supplies. The "Micro Drug" computer-based management system is also being rebuilt. A WHO pharmacist in Basra is coordinating with the central warehouse managers to identify the needs in the four Governorates of the South, Basra included. He is helping to speed up the distribution of the drugs to the health facilities throughout the governorate. Yesterday, with a colleague from the warehouse, he visited four hospitals to evaluate the available stocks.

Security for health facilities

The process of recruiting and training security guards for hospitals, warehouses and other facilities has begun. There have been huge problems with security in health facilities since the end of the conflict and guards are urgently needed. Initially, 104 people will be recruited and trained. This is the first batch of a security team which will eventually number 3 000 and which will provide security for key hospitals and medical warehouses in Baghdad and throughout Iraq. Unfortunately, this is a key priority as without security it is not possible for the health system to function. There have been many reports of doctors, nurses, lorry drivers and others being threatened in the course of their work. They must be protected if they are to continue doing their vital work.